Титульные страницы и содержание

BACKGROUND: Psychotropic drugs are prescribed to approximately 30-40% of adults with intellectual disability (ID) and challenging behaviour, despite the limited evidence of effectiveness and the potential of adverse events. AIMS: To assess the prevalence of adverse events in association with psychotropic drug use in adults with ID and challenging behaviour and to examine the relation of these adverse events with the person's quality of life. METHOD: The presence of adverse events was measured with a questionnaire that had to be filled in by the physicians of the participants. Movement disorders were measured separately with a standardised protocol. The strength of the association between adverse events and Intellectual Disability Quality of Life-16 (IDQOL-16), and daily functioning was investigated using linear regression analyses, taking into account the severity of disease (CGI-S) as potential confounder. RESULTS: Virtually all of 103 adults with ID and challenging behaviour had at least one adverse event (84.4%) and almost half had ≥3 adverse events (45.6%) across different subclasses. Using psychotropic drugs increased the prevalence of adverse events significantly. Respectively 13% of the patients without psychotropic drugs and 61% of the patients with ≥2 psychotropic drugs had ≥3 adverse events. Having adverse events had a significantly negative influence on the quality of life. CONCLUSIONS: A large majority of all patients had at least one adverse event associated with psychotropic drug use. More attention is needed for these adverse events and their negative influence on the quality of life of these patients, taking into account the lack of evidence of effectiveness of psychotropic drugs for challenging behaviour

EEG neurofeedback for executive functions in children with neurodevelopmental challenges

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of EEG neurofeedback as treatment for inhibition and updating problems in children facing neurodevelopmental challenges

An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

Background People with intellectual disability (ID) have poorer health than the general population; however, there is a lack of comprehensive national data describing their health-care needs and utilisation. Annual health checks for adults with ID have been incentivised through primary care since 2009, but only half of those eligible for such a health check receive one. It is unclear what impact health checks have had on important health outcomes, such as emergency hospitalisation. Objectives To evaluate whether or not annual health checks for adults with ID have reduced emergency hospitalisation, and to describe health, health care and mortality for adults with ID. Design A retrospective matched cohort study using primary care data linked to national hospital admissions and mortality data sets. Setting A total of 451 English general practices contributing data to Clinical Practice Research Datalink (CPRD). Participants A total of 21,859 adults with ID compared with 152,846 age-, gender- and practice-matched controls without ID registered during 2009–13. Interventions None. Main outcome measures Emergency hospital admissions. Other outcomes – preventable admissions for ambulatory care sensitive conditions, and mortality. Data sources CPRD, Hospital Episodes Statistics and Office for National Statistics. Results Compared with the general population, adults with ID had higher levels of recorded comorbidity and were more likely to consult in primary care. However, they were less likely to have long doctor consultations, and had lower continuity of care. They had higher mortality rates [hazard ratio (HR) 3.6, 95% confidence interval (CI) 3.3 to 3.9], with 37.0% of deaths classified as being amenable to health-care intervention (HR 5.9, 95% CI 5.1 to 6.8). They were more likely to have emergency hospital admissions [incidence rate ratio (IRR) 2.82, 95% CI 2.66 to 2.98], with 33.7% deemed preventable compared with 17.3% in controls (IRR 5.62, 95% CI 5.14 to 6.13). Health checks for adults with ID had no effect on overall emergency admissions compared with controls (IRR 0.96, 95% CI 0.87 to 1.07), although there was a relative reduction in emergency admissions for ambulatory care-sensitive conditions (IRR 0.82, 95% CI 0.69 to 0.99). Practices with high health check participation also showed a relative fall in preventable emergency admissions for their patients with ID, compared with practices with minimal participation (IRR 0.73, 95% CI 0.57 to 0.95). There were large variations in the health check-related content that was recorded on electronic records. Limitations Patients with milder ID not known to health services were not identified. We could not comment on the quality of health checks. Conclusions Compared with the general population, adults with ID have more chronic diseases and greater primary and secondary care utilisation. With more than one-third of deaths potentially amenable to health-care interventions, improvements in access to, and quality of, health care are required. In primary care, better continuity of care and longer appointment times are important examples that we identified. Although annual health checks can also improve access, not every eligible adult with ID receives one, and health check content varies by practice. Health checks had no impact on overall emergency admissions, but they appeared influential in reducing preventable emergency admissions. Future work No formal cost-effectiveness analysis of annual health checks was performed, but this could be attempted in relation to our estimates of a reduction in preventable emergency admissions. Funding The National Institute for Health Research Health Services and Delivery Research programme

НОВЫЕ РЕШЕНИЯ ПОВЫШЕНИЯ ЭКСПЛУАТАЦИОННОЙ УСТОЙЧИВОСТИ ГОРНЫХ ВЫРАБОТОК

Розглянуто два концептуальних підходи про початковий напружено- деформований стан навколо виробок різного призначення. Обґрунтовано наукові передумови зі створення кріплень нового технічного рівня. Представлено блок-схему реалізованих і перспективних заходів щодо створення нових конструкцій металорамних кріплень, які забезпечують ресурсозберігаючу експлуатаційну стійкість гірничих виробок для складних гірничо-геологічних умов. Рассмотрены два концептуальных подхода о начальном напряженно- деформированном состоянии в окрестности выработок различного назначения. Обоснованы научные предпосылки по созданию крепей нового технического уровня. Представлена блок-схема реализуемых и перспективных мероприятий по созданию новых конструкций металлорамных крепей обеспечивающих ресурсосберегающую эксплуатационную устойчивость горных вы- работок для сложных горно-геологических условий. Two conceptual approaches about initial stress-strain state in the vicinity of mine workings of various purpose are considered. Scientific preconditions focused on new technical level mine supports creation are substantiated. Block diagram of the realized and perspective measures focused on new constructions of metal- frame supports creation that provide resource-saving exploitation stability of mine workings for complex mining-geological conditions is presented

Prevalence of challenging behaviour in adults with intellectual disabilities, correlates, and association with mental health

Purpose of Review To summarise findings about the prevalence and correlates of challenging behaviour in adults with intellectual disabilities from robust research. We also describe findings on the interplay between challenging behaviour and mental health. Recent Findings Recent studies that have utilised psychometrically evaluated tools, with clear operational definitions, show similar findings on the prevalence of challenging behaviour of about 1 in every 5–6 adults known to services. We describe common correlates identified such as communication impairments, severity of intellectual disability, and living in institutional settings or congregate care. We also describe the complex and multifaceted relationship between challenging behaviour and mental health. Summary Based on recent studies, we propose a revised framework model to help understand challenging behaviour. We propose a number of areas where more research is required, particularly the development of risk tools clinicians can utilise in practice

The plant root economics space in relation to nutrient limitation in Eurasian herbaceous plant communities

Plant species occupy distinct niches along a nitrogen-to-phosphorus (N:P) gradient, yet there is no general framework for belowground nutrient acquisition traits in relation to N or P limitation. We retrieved several belowground traits from databases, placed them in the “root economics space” framework, and linked these to a dataset of 991 plots in Eurasian herbaceous plant communities, containing plant species composition, aboveground community biomass and tissue N and P concentrations. Our results support that under increasing N:P ratio, belowground nutrient acquisition strategies shift from “fast” to “slow” and from “do-it-yourself” to “outsourcing”, with alternative “do-it-yourself” to “outsourcing” strategies at both ends of the spectrum. Species' mycorrhizal capacity patterns conflicted with root economics space predictions based on root diameter, suggesting evolutionary development of alternative strategies under P limitation. Further insight into belowground strategies along nutrient stoichiometry is crucial for understanding the high abundance of threatened plant species under P limitation

NPtraits

A dataset describing the relationship between nitrogen to phosphorus ratio and plant belowground traits. Scheifes, D.J.P., te Beest, M., Olde Venterink, H., Jansen, A., Kinsbergen, D.T.P. & Wassen, M.J. (2024) The plant root economics space in relation to nutrient limitation in Eurasian herbaceous plant communities. Ecology Letters, 27, e14402. Available from: https://doi.org/10.1111/ele.1440